EP0304986A2 - Verwendung von bestimmten Calcium-Citrate-Malaten zur Herstellung einer pharmazeutischen Zubereitung für die Behandlung von Osteoporose. - Google Patents
Verwendung von bestimmten Calcium-Citrate-Malaten zur Herstellung einer pharmazeutischen Zubereitung für die Behandlung von Osteoporose. Download PDFInfo
- Publication number
- EP0304986A2 EP0304986A2 EP88201733A EP88201733A EP0304986A2 EP 0304986 A2 EP0304986 A2 EP 0304986A2 EP 88201733 A EP88201733 A EP 88201733A EP 88201733 A EP88201733 A EP 88201733A EP 0304986 A2 EP0304986 A2 EP 0304986A2
- Authority
- EP
- European Patent Office
- Prior art keywords
- calcium
- malate
- bone
- subject
- building
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Granted
Links
- 229940092124 calcium citrate malate Drugs 0.000 title claims abstract description 63
- MPCMQXRREZMSPJ-UHFFFAOYSA-L calcium;2-hydroxybutanedioate;2-hydroxypropane-1,2,3-tricarboxylic acid;pentahydrate Chemical compound O.O.O.O.O.[Ca+2].[O-]C(=O)C(O)CC([O-])=O.OC(=O)CC(O)(C(O)=O)CC(O)=O MPCMQXRREZMSPJ-UHFFFAOYSA-L 0.000 title claims abstract description 62
- 208000001132 Osteoporosis Diseases 0.000 title claims abstract description 40
- 238000011282 treatment Methods 0.000 title claims abstract description 19
- 239000003814 drug Substances 0.000 title description 5
- 238000004519 manufacturing process Methods 0.000 title 1
- 238000000034 method Methods 0.000 claims abstract description 57
- 210000000988 bone and bone Anatomy 0.000 claims abstract description 48
- BJEPYKJPYRNKOW-UHFFFAOYSA-N malic acid Chemical compound OC(=O)C(O)CC(O)=O BJEPYKJPYRNKOW-UHFFFAOYSA-N 0.000 claims abstract description 30
- 229940049920 malate Drugs 0.000 claims abstract description 24
- KRKNYBCHXYNGOX-UHFFFAOYSA-K Citrate Chemical compound [O-]C(=O)CC(O)(CC([O-])=O)C([O-])=O KRKNYBCHXYNGOX-UHFFFAOYSA-K 0.000 claims abstract description 23
- 241001465754 Metazoa Species 0.000 claims abstract description 9
- OYPRJOBELJOOCE-UHFFFAOYSA-N Calcium Chemical compound [Ca] OYPRJOBELJOOCE-UHFFFAOYSA-N 0.000 claims description 35
- 239000011575 calcium Substances 0.000 claims description 32
- 229910052791 calcium Inorganic materials 0.000 claims description 32
- 235000013361 beverage Nutrition 0.000 claims description 8
- 239000002552 dosage form Substances 0.000 claims description 8
- 208000010392 Bone Fractures Diseases 0.000 claims description 5
- 238000001514 detection method Methods 0.000 claims description 3
- 239000008297 liquid dosage form Substances 0.000 claims description 3
- 235000011389 fruit/vegetable juice Nutrition 0.000 claims description 2
- 239000007909 solid dosage form Substances 0.000 claims description 2
- 239000000203 mixture Substances 0.000 abstract description 31
- 159000000007 calcium salts Chemical class 0.000 abstract description 8
- 239000006186 oral dosage form Substances 0.000 abstract description 6
- 239000003937 drug carrier Substances 0.000 abstract description 5
- 239000000546 pharmaceutical excipient Substances 0.000 abstract description 3
- 229960005069 calcium Drugs 0.000 description 30
- KRKNYBCHXYNGOX-UHFFFAOYSA-N citric acid Chemical compound OC(=O)CC(O)(C(O)=O)CC(O)=O KRKNYBCHXYNGOX-UHFFFAOYSA-N 0.000 description 18
- 239000003826 tablet Substances 0.000 description 13
- VTYYLEPIZMXCLO-UHFFFAOYSA-L Calcium carbonate Chemical compound [Ca+2].[O-]C([O-])=O VTYYLEPIZMXCLO-UHFFFAOYSA-L 0.000 description 12
- 239000000243 solution Substances 0.000 description 10
- 239000003795 chemical substances by application Substances 0.000 description 9
- 208000037265 diseases, disorders, signs and symptoms Diseases 0.000 description 9
- 208000035475 disorder Diseases 0.000 description 8
- 235000011090 malic acid Nutrition 0.000 description 8
- XLYOFNOQVPJJNP-UHFFFAOYSA-N water Substances O XLYOFNOQVPJJNP-UHFFFAOYSA-N 0.000 description 8
- BJEPYKJPYRNKOW-REOHCLBHSA-N (S)-malic acid Chemical compound OC(=O)[C@@H](O)CC(O)=O BJEPYKJPYRNKOW-REOHCLBHSA-N 0.000 description 7
- 235000015165 citric acid Nutrition 0.000 description 7
- 239000001630 malic acid Substances 0.000 description 7
- 229910000019 calcium carbonate Inorganic materials 0.000 description 6
- 230000000694 effects Effects 0.000 description 6
- 230000008569 process Effects 0.000 description 6
- 230000002411 adverse Effects 0.000 description 5
- 210000002997 osteoclast Anatomy 0.000 description 5
- 208000001685 postmenopausal osteoporosis Diseases 0.000 description 5
- CURLTUGMZLYLDI-UHFFFAOYSA-N Carbon dioxide Chemical compound O=C=O CURLTUGMZLYLDI-UHFFFAOYSA-N 0.000 description 4
- 239000012141 concentrate Substances 0.000 description 4
- HQKMJHAJHXVSDF-UHFFFAOYSA-L magnesium stearate Chemical compound [Mg+2].CCCCCCCCCCCCCCCCCC([O-])=O.CCCCCCCCCCCCCCCCCC([O-])=O HQKMJHAJHXVSDF-UHFFFAOYSA-L 0.000 description 4
- 235000016709 nutrition Nutrition 0.000 description 4
- 230000001009 osteoporotic effect Effects 0.000 description 4
- 238000003756 stirring Methods 0.000 description 4
- 206010065687 Bone loss Diseases 0.000 description 3
- 239000002253 acid Substances 0.000 description 3
- 230000037182 bone density Effects 0.000 description 3
- FNAQSUUGMSOBHW-UHFFFAOYSA-H calcium citrate Chemical compound [Ca+2].[Ca+2].[Ca+2].[O-]C(=O)CC(O)(CC([O-])=O)C([O-])=O.[O-]C(=O)CC(O)(CC([O-])=O)C([O-])=O FNAQSUUGMSOBHW-UHFFFAOYSA-H 0.000 description 3
- 239000001354 calcium citrate Substances 0.000 description 3
- 229940069978 calcium supplement Drugs 0.000 description 3
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- 235000015205 orange juice Nutrition 0.000 description 3
- 210000000963 osteoblast Anatomy 0.000 description 3
- 239000000843 powder Substances 0.000 description 3
- 235000013337 tricalcium citrate Nutrition 0.000 description 3
- 208000006386 Bone Resorption Diseases 0.000 description 2
- 241000282412 Homo Species 0.000 description 2
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- 150000001450 anions Chemical class 0.000 description 2
- 230000008901 benefit Effects 0.000 description 2
- 230000010072 bone remodeling Effects 0.000 description 2
- 230000024279 bone resorption Effects 0.000 description 2
- 229960004256 calcium citrate Drugs 0.000 description 2
- 239000001569 carbon dioxide Substances 0.000 description 2
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- 230000007794 irritation Effects 0.000 description 2
- XMGQYMWWDOXHJM-UHFFFAOYSA-N limonene Chemical compound CC(=C)C1CCC(C)=CC1 XMGQYMWWDOXHJM-UHFFFAOYSA-N 0.000 description 2
- 235000019359 magnesium stearate Nutrition 0.000 description 2
- -1 malate anions Chemical class 0.000 description 2
- 238000002844 melting Methods 0.000 description 2
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- 230000011164 ossification Effects 0.000 description 2
- 238000002360 preparation method Methods 0.000 description 2
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- 238000005303 weighing Methods 0.000 description 2
- 206010003694 Atrophy Diseases 0.000 description 1
- 208000020084 Bone disease Diseases 0.000 description 1
- UXVMQQNJUSDDNG-UHFFFAOYSA-L Calcium chloride Chemical compound [Cl-].[Cl-].[Ca+2] UXVMQQNJUSDDNG-UHFFFAOYSA-L 0.000 description 1
- BVKZGUZCCUSVTD-UHFFFAOYSA-L Carbonate Chemical compound [O-]C([O-])=O BVKZGUZCCUSVTD-UHFFFAOYSA-L 0.000 description 1
- FBPFZTCFMRRESA-KVTDHHQDSA-N D-Mannitol Chemical compound OC[C@@H](O)[C@@H](O)[C@H](O)[C@H](O)CO FBPFZTCFMRRESA-KVTDHHQDSA-N 0.000 description 1
- KRHYYFGTRYWZRS-UHFFFAOYSA-M Fluoride anion Chemical compound [F-] KRHYYFGTRYWZRS-UHFFFAOYSA-M 0.000 description 1
- 206010023509 Kyphosis Diseases 0.000 description 1
- 229930195725 Mannitol Natural products 0.000 description 1
- 208000030136 Marchiafava-Bignami Disease Diseases 0.000 description 1
- 239000002202 Polyethylene glycol Substances 0.000 description 1
- 241000220010 Rhode Species 0.000 description 1
- 229930006000 Sucrose Natural products 0.000 description 1
- CZMRCDWAGMRECN-UGDNZRGBSA-N Sucrose Chemical compound O[C@H]1[C@H](O)[C@@H](CO)O[C@@]1(CO)O[C@@H]1[C@H](O)[C@@H](O)[C@H](O)[C@@H](CO)O1 CZMRCDWAGMRECN-UGDNZRGBSA-N 0.000 description 1
- 150000007513 acids Chemical class 0.000 description 1
- 230000003213 activating effect Effects 0.000 description 1
- 239000007864 aqueous solution Substances 0.000 description 1
- 230000037444 atrophy Effects 0.000 description 1
- 239000011230 binding agent Substances 0.000 description 1
- 210000002449 bone cell Anatomy 0.000 description 1
- 210000002805 bone matrix Anatomy 0.000 description 1
- 230000002308 calcification Effects 0.000 description 1
- 239000001110 calcium chloride Substances 0.000 description 1
- 229910001628 calcium chloride Inorganic materials 0.000 description 1
- 229960002713 calcium chloride Drugs 0.000 description 1
- 229940078512 calcium gluceptate Drugs 0.000 description 1
- 239000004227 calcium gluconate Substances 0.000 description 1
- 229960004494 calcium gluconate Drugs 0.000 description 1
- 235000013927 calcium gluconate Nutrition 0.000 description 1
- MKJXYGKVIBWPFZ-UHFFFAOYSA-L calcium lactate Chemical compound [Ca+2].CC(O)C([O-])=O.CC(O)C([O-])=O MKJXYGKVIBWPFZ-UHFFFAOYSA-L 0.000 description 1
- 239000001527 calcium lactate Substances 0.000 description 1
- 235000011086 calcium lactate Nutrition 0.000 description 1
- 229960002401 calcium lactate Drugs 0.000 description 1
- OLOZVPHKXALCRI-UHFFFAOYSA-L calcium malate Chemical compound [Ca+2].[O-]C(=O)C(O)CC([O-])=O OLOZVPHKXALCRI-UHFFFAOYSA-L 0.000 description 1
- 239000001362 calcium malate Substances 0.000 description 1
- 229940016114 calcium malate Drugs 0.000 description 1
- 235000011038 calcium malates Nutrition 0.000 description 1
- 239000001506 calcium phosphate Substances 0.000 description 1
- 229910000389 calcium phosphate Inorganic materials 0.000 description 1
- 229960001714 calcium phosphate Drugs 0.000 description 1
- 235000011010 calcium phosphates Nutrition 0.000 description 1
- 239000011635 calcium salts of citric acid Substances 0.000 description 1
- 235000019842 calcium salts of citric acid Nutrition 0.000 description 1
- FATUQANACHZLRT-XBQZYUPDSA-L calcium;(2r,3r,4s,5r,6r)-2,3,4,5,6,7-hexahydroxyheptanoate Chemical compound [Ca+2].OC[C@@H](O)[C@@H](O)[C@H](O)[C@@H](O)[C@@H](O)C([O-])=O.OC[C@@H](O)[C@@H](O)[C@H](O)[C@@H](O)[C@@H](O)C([O-])=O FATUQANACHZLRT-XBQZYUPDSA-L 0.000 description 1
- NEEHYRZPVYRGPP-UHFFFAOYSA-L calcium;2,3,4,5,6-pentahydroxyhexanoate Chemical compound [Ca+2].OCC(O)C(O)C(O)C(O)C([O-])=O.OCC(O)C(O)C(O)C(O)C([O-])=O NEEHYRZPVYRGPP-UHFFFAOYSA-L 0.000 description 1
- 239000002775 capsule Substances 0.000 description 1
- 239000012295 chemical reaction liquid Substances 0.000 description 1
- 239000007910 chewable tablet Substances 0.000 description 1
- 229940068682 chewable tablet Drugs 0.000 description 1
- 150000001860 citric acid derivatives Chemical class 0.000 description 1
- 239000011248 coating agent Substances 0.000 description 1
- 238000000576 coating method Methods 0.000 description 1
- 238000004040 coloring Methods 0.000 description 1
- 235000021557 concentrated beverage Nutrition 0.000 description 1
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- 230000001054 cortical effect Effects 0.000 description 1
- 230000000994 depressogenic effect Effects 0.000 description 1
- 238000012631 diagnostic technique Methods 0.000 description 1
- XQRLCLUYWUNEEH-UHFFFAOYSA-L diphosphonate(2-) Chemical compound [O-]P(=O)OP([O-])=O XQRLCLUYWUNEEH-UHFFFAOYSA-L 0.000 description 1
- 201000010099 disease Diseases 0.000 description 1
- 239000003995 emulsifying agent Substances 0.000 description 1
- 239000000839 emulsion Substances 0.000 description 1
- 235000019634 flavors Nutrition 0.000 description 1
- 238000005187 foaming Methods 0.000 description 1
- 235000003599 food sweetener Nutrition 0.000 description 1
- 238000004108 freeze drying Methods 0.000 description 1
- 235000015203 fruit juice Nutrition 0.000 description 1
- 238000013110 gastrectomy Methods 0.000 description 1
- 230000036541 health Effects 0.000 description 1
- XLYOFNOQVPJJNP-UHFFFAOYSA-M hydroxide Chemical compound [OH-] XLYOFNOQVPJJNP-UHFFFAOYSA-M 0.000 description 1
- 239000001866 hydroxypropyl methyl cellulose Substances 0.000 description 1
- 229920003088 hydroxypropyl methyl cellulose Polymers 0.000 description 1
- 235000010979 hydroxypropyl methyl cellulose Nutrition 0.000 description 1
- UFVKGYZPFZQRLF-UHFFFAOYSA-N hydroxypropyl methyl cellulose Chemical compound OC1C(O)C(OC)OC(CO)C1OC1C(O)C(O)C(OC2C(C(O)C(OC3C(C(O)C(O)C(CO)O3)O)C(CO)O2)O)C(CO)O1 UFVKGYZPFZQRLF-UHFFFAOYSA-N 0.000 description 1
- 201000000916 idiopathic juvenile osteoporosis Diseases 0.000 description 1
- 238000011065 in-situ storage Methods 0.000 description 1
- 230000001939 inductive effect Effects 0.000 description 1
- 229910052816 inorganic phosphate Inorganic materials 0.000 description 1
- 235000021579 juice concentrates Nutrition 0.000 description 1
- 239000003446 ligand Substances 0.000 description 1
- 239000000314 lubricant Substances 0.000 description 1
- 239000000594 mannitol Substances 0.000 description 1
- 235000010355 mannitol Nutrition 0.000 description 1
- 238000005259 measurement Methods 0.000 description 1
- 230000007246 mechanism Effects 0.000 description 1
- 230000002503 metabolic effect Effects 0.000 description 1
- 230000004220 muscle function Effects 0.000 description 1
- 210000005036 nerve Anatomy 0.000 description 1
- 230000007935 neutral effect Effects 0.000 description 1
- 230000035764 nutrition Effects 0.000 description 1
- 238000011903 nutritional therapy Methods 0.000 description 1
- 238000000643 oven drying Methods 0.000 description 1
- 230000000144 pharmacologic effect Effects 0.000 description 1
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- 239000003755 preservative agent Substances 0.000 description 1
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- 210000002784 stomach Anatomy 0.000 description 1
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- 239000013589 supplement Substances 0.000 description 1
- 239000000375 suspending agent Substances 0.000 description 1
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- 229940124597 therapeutic agent Drugs 0.000 description 1
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- 230000004797 therapeutic response Effects 0.000 description 1
- 210000001519 tissue Anatomy 0.000 description 1
- QORWJWZARLRLPR-UHFFFAOYSA-H tricalcium bis(phosphate) Chemical compound [Ca+2].[Ca+2].[Ca+2].[O-]P([O-])([O-])=O.[O-]P([O-])([O-])=O QORWJWZARLRLPR-UHFFFAOYSA-H 0.000 description 1
- 210000000707 wrist Anatomy 0.000 description 1
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K33/00—Medicinal preparations containing inorganic active ingredients
- A61K33/06—Aluminium, calcium or magnesium; Compounds thereof, e.g. clay
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61K—PREPARATIONS FOR MEDICAL, DENTAL OR TOILETRY PURPOSES
- A61K31/00—Medicinal preparations containing organic active ingredients
- A61K31/185—Acids; Anhydrides, halides or salts thereof, e.g. sulfur acids, imidic, hydrazonic or hydroximic acids
- A61K31/19—Carboxylic acids, e.g. valproic acid
-
- A—HUMAN NECESSITIES
- A23—FOODS OR FOODSTUFFS; TREATMENT THEREOF, NOT COVERED BY OTHER CLASSES
- A23L—FOODS, FOODSTUFFS OR NON-ALCOHOLIC BEVERAGES, NOT OTHERWISE PROVIDED FOR; PREPARATION OR TREATMENT THEREOF
- A23L33/00—Modifying nutritive qualities of foods; Dietetic products; Preparation or treatment thereof
- A23L33/10—Modifying nutritive qualities of foods; Dietetic products; Preparation or treatment thereof using additives
- A23L33/16—Inorganic salts, minerals or trace elements
- A23L33/165—Complexes or chelates
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P19/00—Drugs for skeletal disorders
- A61P19/08—Drugs for skeletal disorders for bone diseases, e.g. rachitism, Paget's disease
- A61P19/10—Drugs for skeletal disorders for bone diseases, e.g. rachitism, Paget's disease for osteoporosis
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P3/00—Drugs for disorders of the metabolism
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P3/00—Drugs for disorders of the metabolism
- A61P3/12—Drugs for disorders of the metabolism for electrolyte homeostasis
- A61P3/14—Drugs for disorders of the metabolism for electrolyte homeostasis for calcium homeostasis
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61P—SPECIFIC THERAPEUTIC ACTIVITY OF CHEMICAL COMPOUNDS OR MEDICINAL PREPARATIONS
- A61P43/00—Drugs for specific purposes, not provided for in groups A61P1/00-A61P41/00
Definitions
- This invention relates to methods of building bone in humans and other animals, i.e., for the treatment of osteoporosis and related disorders.
- this invention relates to such methods of treatment by administration of certain calcium salts.
- Calcium is the fifth most abundant element in the human body. It plays an important role in many physiological processes, including nerve and muscle functions. Not surprisingly, nutritional and metabolic deficiencies of calcium can have broad-ranging adverse effects. Since about 90% of the body's calcium is found in bone tissues, many of these adverse effects are manifested through deficiencies in the structure, function and integrity of the skeletal system.
- Osteoporosis can be generally defined as the reduction in the quantity of bone, or the atrophy of skeletal tissue. In general, there are two types of osteoporosis: primary and secondary. "Secondary osteoporosis" is the result of an identifiable disease process or agent. However, approximately 90% of all osteoporosis cases is idiopathic "primary osteoporosis". Such primary osteoporosis includes postmenopausal osteoporosis, age-associated osteoporosis (affecting a majority of individuals over the age of 70 to 80), and idiopathic osteoporosis affecting middle-aged and younger men and women.
- Bone fractures often occur, for example, in the wrist and spine of women suffering from postmenopausal osteoporosis. Kyphosis (abnormally increased curvature of the thoracic spine) may also result.
- Bone remodeling occurs throughout life, renewing the skeleton and maintaining the strength of bone. This remodeling occurs in a series of discrete pockets of activity in the bone, called “osteoclasts” and “steoblasts”. Osteoclasts (bone dissolving or resorbing cells) are responsible for the resorption of a portion of bone within the bone matrix, during the resorption process. After resorption, the osteoclasts are followed by the appearance of osteoblasts (bone forming cells), which then refill the resorbed portion with new bone.
- osteoblasts bone forming cells
- osteoporotics In a healthy adult, the rate at which the osteoclasts and osteoblasts are formed maintains a balance of bone resorption and bone formation. However, in osteoporotics an imbalance in this remodeling process develops, resulting in loss of bone at a rate faster than the accretion of bone. This imbalance is much more severe, and occurs at a younger age, in osteoporotics as compared to healthy adults.
- compositions and methods are described in the medical literature for the "treatment” of osteoporosis. Many of these compositions and methods attempt to either slow the loss of bone or to produce a net gain in bone mass. See, for example, R. C. Haynes, Jr. et al., "Agents affecting Calcification", The Pharmacological Basis of Therapeutics , 7th Edition (A. G. Gilman, L. S. Goodman et al., Editors, 1985); and G. D. Whedon et al., "An Analysis of Current Concepts and Research Interest in Osteoporosis", Current Advances in Skeletogenesis (A. Ornoy et al., Editors, 1985). Estrogen is often used to affect the metabolism of calcium.
- Nutritional therapies for osteoporosis have also been proposed. Many calcium-containing compounds and compositions have been described for use as nutritional supplements. Many commercial preparations are also available, typically containing calcium carbonate. Calcium chloride, calcium gluceptate, calcium gluconate, calcium lactate, calcium phosphate, calcium citrate, and other calcium salts have also been described for use in calcium supplements.
- the use of calcium citrate for example, is described in French Patent 2,219,778, Monteau, published September 27, 1974; and World Patent Publications 86/04814 and 86/04815, Pak et al., both published August 28, 1986.
- Food supplements containing calcium citrate malate are described in Japanese Patent Document 56/97, 248, Kawai, published August 5, 1981.
- the present invention provides methods for building bone in a human or other animal subject, comprising administering to said subject a safe and effective amount of calcium citrate malate.
- the calcium citrate malate comprises a complex or a mixture of calcium salts having a ratio of moles citrate to moles malate to from about 1:0.16 to about 1:13.5.
- a preferred calcium citrate malate for use in the methods of this invention has a molar composition of calcium:citrate:malate of about 6:2:3.
- the calcium citrate malate is preferably administered in an oral dosage form, containing pharmaceutically-acceptable carriers and excipients.
- the methods of the present invention comprise the administration of calcium citrate malate to a human or other animal subject.
- Specific compounds and compositions to be used in these processes must, accordingly, be pharmaceutically-acceptable.
- a “pharmaceutically-acceptable” component is one that is suitable for use with humans and/or animals without undue adverse side effects (such as toxicity, irritation, and allergic response) commensurate with a reasonable benefit/risk ratio.
- the term "safe and effective amount” refers to the quantity of a component which is sufficient to yield a desired therapeutic response without undue adverse side effects (such as toxicity, irritation, or allergic response) commensurate with a reasonable benefit/risk ratio when used in the manner of this invention.
- the specific "safe and effective amount” will, obviously, vary with such factors as the particular condition being treated, the physical condition of the patient, the duration of the treatment, the nature of concurrent therapy (if any), and the specific formulations employed.
- the methods of this invention involve administration of a mixture of calcium salts, herein "calcium citrate malate", comprising calcium salts of citric acid and malic acid.
- the calcium citrate malate may consist of a mixture of calcium citrate and calcium malate, a complex of calcium containing citrate and malate ligands, a mixture of a calcium salt with citric acid and malic acid, or combinations thereof.
- Mattures of a calcium salt and citric and malic acids may be used to form calcium citrate malate in situ , in a liquid dose form, or in the acid environment of the stomach of the subject to whom the mixture is administered.
- the molar ratio of citrate:malate is from about 1:0.16 to about 1:13.5, preferably from about 1:0.5 to about 1:4.5, more preferably from about 1:0.75 to about 1:3.
- a preferred calcium citrate malate has a molar citrate:malate ratio of about 1:1.5.
- the ratio of moles calcium:total moles citrate plus malate is from about 1:0.2 to about 1:1.5, preferably from about 1:0.7 to about 1:0.9, more preferably about 1:0.83.
- the calcium citrate malate may contain other acid anions in addition to citrate and malate.
- Such anions may include, for example, carbonate, hydroxide, and mixtures thereof.
- the calcium citrate malate is neutral, comprised entirely of citrate and malate anions.
- the equivalents of calcium (2 x moles calcium) is about equal to the total number of equivalents of citrate (3 x moles citrate) plus malate (2 x moles malate).
- a preferred calcium citrate malate has a calcium:citrate:malate molar composition of about 6:2:3. Such a preferred calcium citrate malate is described in copending U.S. Patent Application Serial No. (Norwich Eaton Case N-499), Jacobs, "Novel Calcium Supplements", filed August 28, 1987 (incorporated by reference herein).
- the calcium citrate malate for use in the methods of this invention may be provided in solid or liquid dosage forms.
- Calcium citrate malate for use in solid forms may be made, for example, by first dissolving citric acid and malic acid, in the desired molar ratio, in water. Calcium carbonate may then be added to the solution, in such amount that the ratio of moles calcium to moles citrate and moles malate is as desired. Carbon dioxide will be evolved. The solution may then be dried (as by freeze drying or oven drying) to obtain the calcium citrate malate.
- Such dosage forms comprise a safe and effective amount of calcium citrate malate and a pharmaceutically-acceptable carrier.
- the pharmaceutically-acceptable carrier is present at a level of from about 0.1% to about 99%, preferably from about 0.1% to about 75%, by weight of the composition.
- Unit dosage forms i.e., dosage forms containing an amount of calcium citrate malate suitable for administration in one single dose, according to sound medical practice
- Solid forms include tablets, capsules, granules and bulk powders. Aside from the calcium citrate malate, tablets may contain suitable binders, lubricants, diluents, disintegrating agents, coloring agents, flavoring agents, flow-inducing agents and melting agents.
- Liquid oral dosage forms include aqueous solutions, emulsions, suspensions, solutions and/or suspensions reconstituted from non-effervescent granules and effervescent preparations reconstituted from effervescent granules. Such liquid oral dosage forms may contain, for example, suitable solvents, preservatives, emulsifying agents, suspending agents, diluents, sweeteners, melting agents, and coloring and flavoring agents.
- a preferred liquid dosage form contains calcium citrate malate in a juice-containing beverage.
- the present invention provides a method for building bone in a human or other animal subject, comprising administering to said subject a safe and effective amount of calcium citrate malate for a period of time sufficient to achieve an increase in the net skeletal mass of said subject.
- building bone refers to an increase in the net skeletal mass of the subject treated. The increase in mass may be in cortical bone, trabecular bone, or both.
- the net skeletal mass is increased by at least about 0.5%, more preferably at least about 1%.
- administering refers to any method which, in sound medical practice, delivers the calcium citrate malate used in this invention to the subject to be treated in such a manner so as to be effective in the building of bone.
- the calcium citrate malate is administered orally.
- calcium citrate malate is administered to said subject, per day. More preferably, from about 250 milligrams to about 1500 milligrams, more preferably from about 500 milligrams to about 1000 milligrams, of calcium are administered, per day.
- the specific amount of calcium citrate malate to be administered depends upon the relative percentage weight of calcium in the particular calcium citrate malate employed.
- the specific period of time sufficient to achieve an increase in the net skeletal mass of the subject may depend on a variety of factors. Such factors include, for example, the specific calcium citrate malate formulation employed, the amount of calcium citrate malate administered, the age and sex of the subject, the specific disorder to be treated, concomitant therapies employed (if any), the general physical health of the subject (including the presence of other disorders), the extent of bone loss in the individual, and the nutritional habits of the individual. Although the administration of even small quantities of calcium citrate malate may build bone, the net increase in bone mass may not be detectable for short periods of administration.
- the calcium citrate malate is preferably administered for at least about three months, preferably for at least about six months. Of course, such administration may be continued indefinitely, according to sound medical practice.
- the subject is treated until a net skeletal mass is obtained that is clinically determined to be above the fracture threshold for the subject. See, B.L. Riggs et al., "Involutional Osteoporosis” 314 New England J. of Medicine (1986), incorporated by reference herein.
- the methods of this invention may be employed in the treatment of any of a variety of disorders in which the building of bone is desired.
- the human or other animal "subject" of the methods of this invention is "in need” of a method for building bone, i.e., the subject has a disorder for which building of bone would be advantageous according to sound medical practice.
- disorders include, for example, bone fractures and disorders typified by bone loss, such as osteoporosis (both primary and secondary forms).
- a preferred method of this invention is for the treatment of osteoporosis.
- Such methods may include administration of calcium citrate malate alone, or in combination with other therapeutic agents.
- one method of this invention involves administration of calcium citrate malate as part of an "ADFR" regimen.
- a regimen in general, comprises administration to the subject of a bone-cell activating agent (such as an inorganic phosphate); followed by administration of an osteoclast depressant, to inhibit bone resorption (such as a diphosphonate); followed by a "free" period during which osteoblast bone formation occurs. The entire cycle is preferably repeated.
- Another method of this invention involves administration of calcium citrate malate as part of a regimen comprising intermittent dosing of certain polyphosphonate compounds. Such methods comprise administration of the polyphosphonate followed by a "rest period". Such regimens, among those useful herein, are described in European Patent Specification 210,728, Flora et al., "Regimen for Treating Osteoporosis", published February 4, 1987 (incorporated by reference herein). Preferably, calcium citrate malate is administered during the rest period.
- a preferred method for the treatment of osteoporosis includes an initial diagnostic step, to determine the presence of the disorder.
- a preferred method of this invention comprises the steps of performing a diagnostic on a human subject for the detection of osteoporosis and, upon obtaining a positive result from said diagnostic, administering to said subject a safe and effective amount of calcium citrate malate for a period of time sufficient to build bone in said subject.
- Suitable diagnostics for the detection of osteoporosis are well known in the art. Such methods include the measurement of the radiodensity of skeletal radiographs, quantitative computerized tomography, single energy photon absorptiometry, and dual-energy photon absorptiometry. Diagnostic techniques among those useful herein are described in W. A. Peck et al., Physician's Resource Manual on Osteoporosis (1987), published by the National Osteoporosis Foundation (incorporated by reference herein).
- a composition is prepared containing calcium citrate malate having a molar calcium:citrate:malate composition of about 6:2:3.
- the calcium citrate malate is made by first dissolving approximately 384.2 grams of citric acid and approximately 402.3 grams of malic acid in approximately 2 liters of water. This citrate/malate solution is then heated to approximately 55°C (131°F), with stirring. Separately, approximately 600.6 grams of calcium carbonate is added to approximately 1.2 liters of water, forming a slurry, with stirring.
- the citrate/malate solution is then removed from its heat source, and the calcium carbonate slurry is added slowly, with stirring. The rate of addition is controlled, to contain the reaction as carbon dioxide is released. An additional quantity of water, approximately 0.4 liters, is finally added. The reaction mixture is then stirred for approximately 1 to 1.5 hours. The reaction is essentially complete as the pH of the solution equilibrates to approximately 4.3.
- a precipitate of calcium citrate malate is thus formed.
- the excess reaction liquid is filtered off.
- the calcium citrate malate is dried, for approximately 12 hours at approximately 105°C (221°F), reducing the moisture level to less than about 1%.
- the dried product is then milled to approximately 10-20 mesh size, for a swallowable tablet formulation.
- the swallowable tablet dosage form is then made, comprising: Component % (by weight) calcium citrate malate* 99.73 magnesium stearate 0.27 *: having a molar calcium:citrate:malate composition of approximately 6:2:3, made as described above in this Example.
- the tablet formulation is made by thoroughly admixing the powders, and tabletting using a standard tablet press, to form tablets weighing approximately 1104 milligrams. The tablets are then coated, using a pan coater.
- the coating solution contains approximately 11% hydroxypropylmethyl cellulose, approximately 2% polyethylene glycol, approximately 3.5% colorant, and the balance of water.
- the mass of the subject's thoracic vertebrae is determined by dual-energy photon absorptiometry.
- the human subject is then administered 4 of the tablets, comprised as above, each day for three months.
- the mass of the subject's vertebrae is then remeasured, indicating an increase in bone mass.
- a human female subject, suffering from postmenopausal osteoporosis, is treated by a method of this invention.
- a beverage composition is prepared containing calcium citrate malate.
- the beverage is made comprising: Component % (by weight) 65° Brix Orange Juice Concentrate 38.010 aqueous orange essences 10.099 orange pulp 4.958 orange oils 0.037 orange flavor mix 0.257 calcium carbonate 1.065 citric acid 1.249 malic acid 0.992 sucrose 16.710 water 26.623
- a premix solution is prepared by dissolving the sugar and then the acids (citric and malic) in the water. Calcium carbonate is added and the mixture agitated until foaming ceases.
- This premix solution has a calcium to citrate/malate molar ratio of approximately 1:1.31, and a citric acid:malic acid molar ratio of approximately 1:1.14.
- the premix solution is added, with stirring, to the 65° Brix orange juice concentrate, followed by the orange essences, orange pulp, orange oil, and orange flavor mix.
- the resulting calcium-supplemented orange concentrate nectar has a sugar content of 42° Brix, 0.44% by weight calcium, calcium to citrate/malate molar ratio of approximately 1:2.38, and a citric acid:malic acid molar ratio of 1:0.71.
- This concentrated beverage is then diluted, one part concentrate with three parts water, to form a single strength orange nectar beverage in drinkable form.
- the beverage contains 60% orange juice and 0.11% by weight calcium.
- the density of the human subject's vertebrae is measured by computerized tomography. Thereafter, the subject is administered approximately 180 milliliters (6 ounces) of the beverage composition (containing approximately 195 milligrams of calcium), per day, for one year. The vertebral mass of the subject is then remeasured, indicating an increase in bone density.
- a human male subject, suffering from secondary osteoporosis as a result of a partial gastrectomy, is treated by a method of this invention.
- a chewable tablet composition is administered to the subject, comprised as set forth below.
- the tablets are made by thoroughly admixing the powders, and tabletting on a standard tablet press, forming tablets weighing approximately 1844 milligrams. Each tablet contains approximately 250 mg of calcium (on an elemental basis).
- the bone density of the subject's hip is measured by dual-energy photon absorptiometry.
- the subject is then administered 2 of the tablets, comprised as above, each day for six months.
- the bone density of the subject's hip is then remeasured, indicating an increase in the bone mass.
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- Diabetes (AREA)
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- Food Science & Technology (AREA)
- Polymers & Plastics (AREA)
- Acyclic And Carbocyclic Compounds In Medicinal Compositions (AREA)
- Pharmaceuticals Containing Other Organic And Inorganic Compounds (AREA)
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Priority Applications (1)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| AT88201733T ATE88633T1 (de) | 1987-08-28 | 1988-08-15 | Verwendung von bestimmten calcium-citrate-malaten zur herstellung einer pharmazeutischen zubereitung fuer die behandlung von osteoporose. |
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US9100687A | 1987-08-28 | 1987-08-28 | |
| US91006 | 1987-08-28 |
Publications (3)
| Publication Number | Publication Date |
|---|---|
| EP0304986A2 true EP0304986A2 (de) | 1989-03-01 |
| EP0304986A3 EP0304986A3 (en) | 1990-03-07 |
| EP0304986B1 EP0304986B1 (de) | 1993-04-28 |
Family
ID=22225323
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| EP88201733A Expired - Lifetime EP0304986B1 (de) | 1987-08-28 | 1988-08-15 | Verwendung von bestimmten Calcium-Citrate-Malaten zur Herstellung einer pharmazeutischen Zubereitung für die Behandlung von Osteoporose. |
Country Status (9)
| Country | Link |
|---|---|
| EP (1) | EP0304986B1 (de) |
| JP (1) | JP2738541B2 (de) |
| KR (1) | KR970009582B1 (de) |
| AT (1) | ATE88633T1 (de) |
| CA (1) | CA1329774C (de) |
| DE (1) | DE3880587T2 (de) |
| HK (1) | HK94096A (de) |
| IE (1) | IE61451B1 (de) |
| PH (1) | PH25585A (de) |
Cited By (12)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| WO1992005711A1 (en) * | 1990-10-01 | 1992-04-16 | The Procter & Gamble Company | Tooth enamel erosion inhibitor |
| WO1992007475A1 (en) * | 1990-10-31 | 1992-05-14 | The Procter & Gamble Company | Calcium fortified sauces |
| WO1994000107A1 (en) * | 1992-06-30 | 1994-01-06 | The Procter & Gamble Company | Effervescent calcium supplements |
| WO1994009770A1 (en) * | 1992-11-05 | 1994-05-11 | Dompe' Farmaceutici S.P.A. | The use of aryl-, heteroaryl- and alkyltartronic acids as therapeutical agents |
| US5389387A (en) * | 1991-12-26 | 1995-02-14 | The Procter & Gamble Company | Storage stable calcium-supplemented beverage concentrates |
| US5401524A (en) * | 1992-10-21 | 1995-03-28 | The Proctor & Gamble Company | Storage stable calcium-supplemented beverage premix concentrates and syrups |
| US5422128A (en) * | 1991-12-26 | 1995-06-06 | The Procter & Gamble Company | Storage stable calcium-supplemented beverage concentrates |
| US5445837A (en) * | 1992-10-21 | 1995-08-29 | The Procter & Gamble Company | Sweetener supplement fortified with a concentrated bioavailable calcium source and process of making |
| US5468506A (en) * | 1992-10-21 | 1995-11-21 | The Procter & Gamble Company | Concentrated bioavailable calcium source |
| WO2000018258A3 (en) * | 1998-09-29 | 2000-08-03 | Procter & Gamble | Low acid beverages supplemented with nutritional calcium sources |
| US6811800B2 (en) | 1998-09-29 | 2004-11-02 | The Procter & Gamble Co. | Calcium fortified beverages |
| WO2012125524A1 (en) * | 2011-03-16 | 2012-09-20 | The Charlotte-Mecklenburg Hospital Authority D/B/A Carolinas Medical Center | Compositions and methods for the treatment of musculoskeletal related diseases and disorders using metal ion-citrate analog complexes |
Families Citing this family (2)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| CN101505730B (zh) * | 2006-08-17 | 2013-02-13 | 宝洁公司 | 包含柠檬酸苹果酸钙的组合物以及它们的制备方法 |
| TR200908237A2 (tr) | 2009-11-02 | 2011-05-23 | Bi̇lgi̇ç Mahmut | Kalsiyum ve D vitamini içeren farmasötik bileşimler. |
Family Cites Families (3)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| JPS5697248A (en) * | 1979-12-28 | 1981-08-05 | Tanaka Shiro | Conjugated compound of calcium citrate and calcium malate and its preparation |
| FR2601249A1 (fr) * | 1986-07-09 | 1988-01-15 | Sandoz Lab | Nouvelles compositions pharmaceutiques a base de sels de calcium. |
| US4786510A (en) * | 1987-07-02 | 1988-11-22 | The Procter & Gamble Company | Calcium-iron mineral supplements |
-
1988
- 1988-08-15 AT AT88201733T patent/ATE88633T1/de not_active IP Right Cessation
- 1988-08-15 EP EP88201733A patent/EP0304986B1/de not_active Expired - Lifetime
- 1988-08-15 DE DE8888201733T patent/DE3880587T2/de not_active Expired - Lifetime
- 1988-08-25 CA CA000575678A patent/CA1329774C/en not_active Expired - Lifetime
- 1988-08-26 KR KR88010858A patent/KR970009582B1/ko not_active Expired - Lifetime
- 1988-08-26 IE IE260988A patent/IE61451B1/en not_active IP Right Cessation
- 1988-08-26 PH PH37460A patent/PH25585A/en unknown
- 1988-08-27 JP JP63213488A patent/JP2738541B2/ja not_active Expired - Lifetime
-
1996
- 1996-05-30 HK HK94096A patent/HK94096A/en not_active IP Right Cessation
Cited By (15)
| Publication number | Priority date | Publication date | Assignee | Title |
|---|---|---|---|---|
| WO1992005711A1 (en) * | 1990-10-01 | 1992-04-16 | The Procter & Gamble Company | Tooth enamel erosion inhibitor |
| WO1992007475A1 (en) * | 1990-10-31 | 1992-05-14 | The Procter & Gamble Company | Calcium fortified sauces |
| US5215769A (en) * | 1990-10-31 | 1993-06-01 | The Procter & Gamble Company | Calcium fortified dressing salad product |
| US5422128A (en) * | 1991-12-26 | 1995-06-06 | The Procter & Gamble Company | Storage stable calcium-supplemented beverage concentrates |
| US5389387A (en) * | 1991-12-26 | 1995-02-14 | The Procter & Gamble Company | Storage stable calcium-supplemented beverage concentrates |
| WO1994000107A1 (en) * | 1992-06-30 | 1994-01-06 | The Procter & Gamble Company | Effervescent calcium supplements |
| US5401524A (en) * | 1992-10-21 | 1995-03-28 | The Proctor & Gamble Company | Storage stable calcium-supplemented beverage premix concentrates and syrups |
| US5445837A (en) * | 1992-10-21 | 1995-08-29 | The Procter & Gamble Company | Sweetener supplement fortified with a concentrated bioavailable calcium source and process of making |
| US5468506A (en) * | 1992-10-21 | 1995-11-21 | The Procter & Gamble Company | Concentrated bioavailable calcium source |
| WO1994009770A1 (en) * | 1992-11-05 | 1994-05-11 | Dompe' Farmaceutici S.P.A. | The use of aryl-, heteroaryl- and alkyltartronic acids as therapeutical agents |
| WO2000018258A3 (en) * | 1998-09-29 | 2000-08-03 | Procter & Gamble | Low acid beverages supplemented with nutritional calcium sources |
| US6811800B2 (en) | 1998-09-29 | 2004-11-02 | The Procter & Gamble Co. | Calcium fortified beverages |
| US6994877B2 (en) | 1998-09-29 | 2006-02-07 | The Procter + Gamble Co. | Calcium fortified beverages |
| WO2012125524A1 (en) * | 2011-03-16 | 2012-09-20 | The Charlotte-Mecklenburg Hospital Authority D/B/A Carolinas Medical Center | Compositions and methods for the treatment of musculoskeletal related diseases and disorders using metal ion-citrate analog complexes |
| US9636352B2 (en) | 2011-03-16 | 2017-05-02 | The Charlotte-Mecklenburg Hospital Authority | Compositions and methods for the treatment of musculoskeletal related diseases and disorders using metal ion-citrate analog complexes |
Also Published As
| Publication number | Publication date |
|---|---|
| CA1329774C (en) | 1994-05-24 |
| JP2738541B2 (ja) | 1998-04-08 |
| EP0304986A3 (en) | 1990-03-07 |
| PH25585A (en) | 1991-08-08 |
| HK94096A (en) | 1996-06-07 |
| KR970009582B1 (en) | 1997-06-14 |
| JPH01151515A (ja) | 1989-06-14 |
| IE882609L (en) | 1989-02-28 |
| IE61451B1 (en) | 1994-11-02 |
| ATE88633T1 (de) | 1993-05-15 |
| DE3880587D1 (de) | 1993-06-03 |
| DE3880587T2 (de) | 1993-09-23 |
| KR890003390A (ko) | 1989-04-14 |
| EP0304986B1 (de) | 1993-04-28 |
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